2XU'HUPDWRORJ\2QOLQH Case Report Colocalized nevus depigmentosus and lentigines Prashansa Jaiswal, Sundeep Chowdhry, Paschal D’ Souza Department of Dermatology, Venereology and Leprology, Employees’ State Insurance Corporation Post Graduate Institute of Medical Sciences & Research, Basaidarapur, New Delhi - 110 015, India Corresponding author: Assist. Prof. Sundeep Chowdhry, E-mail: [email protected] ABSTRACT Nevus depigmentosus (ND)is classically defined as a congenital nonprogressive hypopigmented macule, stable in size and distribution. A 17 year girl presented with hypopigmented patch with indented borders, present on the right side of face and neck since 3 years of age. Later on at the age of 5, numerous hyperpigmented punctiform spots appeared exclusively on the hyperpigmented area. On sun exposure, the hypopigmented area neither reddened nor burnt. On diascopy the margin of the hypopigmented lesion remained delineated. The dermoscopic examination showed 1-4 millimeters sized hyperpigmented lesions with a barely visible pseudonet, leading to the final diagnosis of colocalized nevus depigmentosus and lentigines. Key words: Nevus; Hypopigmentation; Reverse; Mutation; Pigmentation INTRODUCTION 25 X 8 centimeters was present at the angle of mouth on right side, further extending to lateral side of right ear, Nevus depigmentosus (ND)is a rare, congenital, right angle of jaw, lateral right side of neck to about 6 stable hypomelanosis first described by Lesser in centimeters below the clavicle. It was irregular in shape 1884 [1]. The lesions usually present as dermatomal with serrated irregular margins. The surface was smooth or quasidermatomal macules commonly on the trunk, and had multiple oval dark brown coloured macules of lower abdomen, or proximal extremities. They are off- 1 to 4 mm in size (Fig. 1). On diascopy the margin of the white in colour and have irregular, serrated, feathered, hypopigmented lesion remained delineated. Adjacent or geographic margins. The face, when involved, oral mucosa was normal. is a cause of social embarrassment for the patient. Unfortunately, there is no effective treatment for this The dermoscopic examination (Fig. 2) showed 1-4 condition. The case is being reported to highlight the millimeter sized hyperpigmented lesions, with a barely phenotypic manifestation of reverse mutation. visible pseudonet, leading to the final diagnosis of colocalized nevus depigmentosus and lentigines CASE REPORT DISCUSSION A 17 year girl presented with hypopigmented patch with indented borders on the right side of face and neck The commonly used clinical diagnostic criteria for which was first noticed by the mother of the child when nevus depigmentosus (ND)are as follows [2-4]: she was 3 years old. Later on at the age of 5, numerous 1. Leukoderma present at birth or of an early onset hyperpigmented punctiform spots appeared exclusively 2. No alteration in distribution of leukoderma on the hyperpigmented area. With sun exposure the throughout life hypopigmented areas neither turned red nor did the 3. No alteration in texture or change of sensation in skin burn at the site. On local examination, a single the affected area ill defined hypopigmented macule of size of about 4. Absence of hyperpigmented border How to cite this article: Jaiswal P, Chowdhry S, D’ Souza P. Colocalized nevus depigmentosus and lentigines. Our Dermatol Online. 2016;7(3):327-328. Submission: 10.12.2015; Acceptance: 26.04.2016 DOI:10.7241/ourd.20163.88 © Our Dermatol Online 3.2016 327 www.odermatol.com nevus [8]. The first one, which applies to larger lesions such as syndrome of Ito, hypothesizes that a mutational event occurring in the first 4 weeks of life when the embryo is a single developmental field, leads to a polytopic malformation, namely more associated malformations. In our case, which is characterized by small nevi, the mutation affecting the same melanocytic function, is the more probable hypothesis [8] which is responsible for nevus depigmentosus. This mutation is followed by a reverse mutation of the gene involved in the pigmentation. The latter could restore the pigmentation incompletely. Thus, colocalization of lentigines can be regarded as a different form of repigmentation resulting from reverse mutation in one Figure 1: Single ill defined hypopigmented macule with lentigenes. of the genes involved in pigmentation [2]. Consent The examination of the patient was conducted according to the Declaration of Helsinki principles. REFERENCES 1. Lesser E. In: Ziemssen HV, editor. Hanbuchder Hautkrankheiten, 2 nd ed. Leipzig: Vogel; 1884. p. 183. 2. Shim JH, Seo SJ, Song KY, Hong CK. Development of multiple pigmented nevi within segmental nevus depigmentosus. J Korean Med Sci. 2002;17:133-6. 3. Bolognia JL, Lazova R, Watsky K. The development of lentigines within segmental achromic nevi. J Am Acad Dermatol. 1998;39:330-3. 4. Khumalo NP, Huson S, Burge S. Development of lentigines within naevoid hypopigmentation. Br J Dermatol. 2001;144:188-9. Figure 2: On dermoscopy dark network across the whole lesion. 5. Bhagwat PV,Kudligi C, Odugoudar SG, Krishna S.Pigmented nevi within segmental nevus depigmentosus – a rare case. J Pak Associat It may be localized, segmental, or systematized [5]. Wood’s Dermatol. 2015;25:76-7. 6. Alkemade H, Juhlin L. Unilateral lentiginosis with nevus lamp examination shows an off-white accentuation depigmentosus on the other side. J Am Acad Dermatol. in ND (compared to chalky-white in vitiligo). 2000;43:361-3. Histopathologically, the numbers of melanocytes are 7. Jagia R, Mendiratt V, Koranne RV, Sardana K, Bhushan P, Solanki RS. Colocalized nevus depigmentosus and lentigines with normal or decreased [2,6] but DOPA reactivity is underlying breast hypoplasia: A case of reverse mutation? Dermatol consistently reduced [2]. Melanosomes are usually Online J. 2004;10:12. normal in size, shape, and internal structure [1], 8. Baba M, Akcali C, Seckin D, Happle R. Segmental lentiginosis with ipsilateral nevus depigmentosus: another example of twin spotting? but can be decreased in number, heteromorphic, Eur J Dermatol. 2002;12:319-21. aggregated in melanocytes, or located in membrane bound aggregates [5]. Until now 8 cases of colocalized nevus depigmentosus Copyright by Prashansa Jaiswal, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, and lentigines have been reported [2-4,6,7,10]. The which permits unrestricted use, distribution, and reproduction in any theory of twin spots does not apply to colocalized nevus. medium, provided the original author and source are credited. Two hypotheses were suggested for the colocalized Source of Support: Nil, Conflict of Interest: None declared. © Our Dermatol Online 3.2016 328.